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Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke

Journal article
Authors S. Mustanoja
J. Putaala
D. Gordin
L. Tulkki
K. Aarnio
J. Pirinen
I. Surakka
J. Sinisalo
M. Lehto
Turgut Tatlisumak
Published in Stroke
Volume 47
Issue 6
Pages 1593-U450
ISSN 0039-2499
Publication year 2016
Published at Institute of Neuroscience and Physiology
Pages 1593-U450
Language en
Links dx.doi.org/10.1161/strokeaha.116.01...
Keywords blood pressure, hypertension, prognosis, stroke, stroke in the young, cerebral autoregulation, heart-association, hypertension, disease, adults, guidelines, management, prognosis, register, finland, Neurosciences & Neurology, Cardiovascular System & Cardiology
Subject categories Neurosciences, Cardiovascular medicine

Abstract

Background and Purpose-High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults. Methods-The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome. Results-Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n = 142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (P < 0.001) and 24-h SBP, diastolic BP, and mean arterial pressure compared with patients without the recurrent stroke. Patients with SBP >= 160 mm Hg compared with those with SBP < 160 mm Hg had significantly more recurrent strokes (hazard ratio 3.3 [95% confidence interval, 2.05-4.55]; P < 0.001) occurring earlier (13.9 years [13.0-14.6] versus 16.2 [15.8-16.6]; P < 0.001) within the follow-up period. In multivariable analyses, higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure were independently associated with the risk of recurrent stroke, while the 24-hour BP levels were not. Conclusions-In young ischemic stroke patients, high acute phase BP levels are independently associated with a high risk of recurrent strokes.

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